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To investigate the current status of digestive endoscopy diagnosis and treatment in Shanghai, and to provide decision-making support for the revision of the diagnostic and treatment standards and quality control criteria of digestive endoscopy in Shanghai. A total of 145 hospitals providing digestive endoscopy service were investigated through an online survey. The main survey contents were the situation of digestive endoscopists, the development of diagnosis and treatment technology, and the quality and safety situation. There were 1 212 digestive endoscopists in Shanghai, accounting for 1.59% of China which ranked first in all registered practioners in 2019. The annual diagnostic and treatment procedures of digestive endoscopy was 1 902.6 thousand, and endoscopists' working pressure was relatively high. In terms of quality control indicator of a single disease, detection rates of early gastrointestinal cancers and adenomas remained at a high level. The number of digestive endoscopists, endoscopic procedures and quality control indicators of a single disease in Shanghai was in a leading position in China in 2019.
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Objective:To analyze characteristics and trend of publications in digestive endoscopy quality control from 2010 to 2021.Methods:The literature on digestive endoscopy quality control from 2010 to 2021 were searched through the Web of Science core collection with the method of bibliometrics. The year of publication, journal name, country, main researchers, institutions and citations were analyzed by Web of Science. Then, the downloaded data were imported into VOSviewer for co-occurrence network analysis of the country, keywords and citations.Results:A total of 3 283 English papers on digestive endoscopy quality control were included. The number of papers from China and other countries showed an upward trend, and citations as well from 2010 to 2021. The publications were mainly from the United States (1 209, 36.8%), the United Kingdom (325, 9.9%), and China (324, 9.9%). The journal with the largest number of publications in this category was Gastrointest Endosc (241, 7.3%). The U.S. Department of Veterans Affairs had 175 publications, ranking the first among all institutions. Research topics were focused on colonoscopy, adenoma detection rate, and artificial intelligence. Conclusion:The research in digestive endoscopy quality control is booming, and the research activity is gradually increasing. Chinese academic influence in this field still needs to be further improved.
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Objective To analyze the micronucleus levels of peripheral blood lymphocytes of medical radiation workers, and to provide a basis for radiation protection to reduce occupational hazards caused by ionizing radiation. Methods A total of 1072 medical radiation workers were selected into radiation group, and 329 healthy adults who underwent pre-employment occupational physical examination and intended to be radiation workers were selected into control group. The micronucleated lymphocyte frequency was determined by whole blood micro-culture. Results There were no significant differences in micronucleated cell frequency and micronucleus frequency between the radiation group and the control group (both P > 0.05). The detection rate of micronucleus abnormalities in the radiation group was significantly higher than that in the control group (P < 0.001). Female radiation workers had significantly higher micronucleated cell frequency, micronucleus frequency, and the detection rate of micronucleus abnormalities than male radiation workers (all P < 0.001). Between different types of work, significant differences were observed in micronucleated cell frequency and micronucleus frequency (both P < 0.05), but not in the detection rate of micronucleus abnormalities (P > 0.05). Radiation workers with different lengths of working showed significant differences in micronucleated cell frequency (P < 0.05), micronucleus frequency (P < 0.05), and the detection rate of micronucleus abnormalities (P < 0.001). Significant differences were observed in micronucleated cell frequency and micronucleus frequency between different age groups (both P < 0.05). The Spearman’s rank correlation analysis showed that micronucleated cell frequency and micronucleus frequency were positively correlated with the age of radiation workers (both P < 0.001). Conclusion The micronucleus frequency of radiation workers was related to the type and length of work, and had a positive correlation with age. Radiation protection should be enhanced for workers engaged in medical radiation for a long period, especially female workers and workers with a long length of service.
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Objective:To evaluate the effects of orthogonal magnetic fields on the dose distribution of 6 MeV X-ray in a uniform water and heterogeneous phantoms.Methods:The Monte Carlo simulation software Gate v8.2 was used to investigate the dose distribution of X-ray beams of different field sizes in a uniform water phantom, water-air/bone-water layer phantom and" custom lung model" in the magnetic field strength of 0.0, 0.5, 1.0, 1.5, 3.0 T, respectively. The relationship between the intensity of magnetic field and the dose distribution of X-rays in the phantoms was analyzed.Results:The existence of a magnetic field would cause the X-ray to shorten the built-up area in the water phantom; when the field was 10 cm×10 cm, the maximum dose on the central axis could change by up to 56.22%(3.0 T). The transverse dose distribution of the radiation field in the direction of the vertical magnetic field shifted to one side by up to 43.64%(-44.55%). The average dose of the air layer in the water-air-water phantom could be reduced by 57.4%(3.0 T). In the water-bone-water phantom, the dose at the proximal end of the bone layer was decreased by 16.5%, whereas the dose at the distal end was increased by 22.6%(1.5 T). The dose change in each layer in the customed lung model was positively correlated with the magnetic field strength.Conclusion:The existence of the orthogonal magnetic field will cause the change of X-ray dose distribution on the built-up area and both sides of the radiation field in the phantoms, which is more obvious adjacent to the interface of heterogeneous phantom.
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Objective:To investigate the independent risk factors for fever after endoscopic radiofrequency ablation (RFA).Methods:From January 2016 to April 2021, 51 patients with early esophageal cancer, who were treated with RFA in the Department of Gastroenterology, Changhai Hospital and whose lesion range exceeded 3/4 of the circumference of esophagus, were included in the case-control study. Patients were divided into fever group ( n=15) and non-fever group ( n=36) according to whether they had fever after operation. The general condition of patients, family history of gastrointestinal tumors, lesion length, lesion range, ablation energy and ablation times were mainly collected for univariate analysis. The variables with P<0.1 were further included in multivariate logistic regression analysis to explore the independent risk factors for fever after RFA. Results:Univariate analysis showed that the lesion length ( t=-3.89, P<0.001), lesion range ( χ2=11.52, P=0.001) and ablation energy ( P=0.001) were significantly different between the two groups. Pearson correlation showed that there was a significant positive correlation between lesion length and lesion circumference ( r=0.71, P<0.001), and the lesion range was determined by the lesion circumference length. Therefore, the two variables of lesion length and ablation energy were finally included in the logistic regression analysis. Logistic regression analysis showed that the risk of fever after RFA was 1.21 times as high as that before when the length of esophageal lesions increased by 1 centimeter (95% CI: 1.01-1.43, P=0.037). The risk of fever after RFA using 12 J ablation energy was 0.43 times as high as that using 10 J ablation energy (95% CI: 0.22-0.85, P=0.015). Conclusion:Lesion length and ablation energy are independent risk factors for fever after esophageal RFA. Patients with long segment early esophageal cancer and using low ablation energy are more likely to have fever after RFA.
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Objective@#To evaluate the efficacy and safety of a novel lumen-apposing metal stent(LAMS) in endoscopic ultrasonography(EUS)-guided transgastric drainage of pancreatic fluid collections(PFC).@*Methods@#A retrospective study of 46 patients was performed who underwent EUS-guided transgastric drainage of PFC with placement of LAMS from September 2015 to April 2017. Clinical data were reviewed and follow-up data were obtained by telephone and outpatient contact.@*Results@#A total of 49 LAMS were placed in 46 patients (2 LAMS were placed in 3 patient respectively for multiport access). The operation success rate was 95.9%(47/49), complications occurred in 14 patients(31.8%), including 2 severe complications (delayed hemorrhage and peritonitis). Additional intervention was performed in 10 patients(22.7%). The mean hospital stay was 6 days (1-40 days) and patients were followed for a mean time of 18.4 months (9-28 months). Treatment success was achieved in 40 patients(90.9%). Stent removal was performed after a mean time of 59.4 days (20-142 days), and recurrence rate was 10%(4/40) during the follow-up period.@*Conclusion@#Drainage of PFC using LAMS with special design is effective and relatively safe.
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Objective To evaluate the efficacy and safety of a novel lumen-apposing metal stent (LAMS) in endoscopic ultrasonography(EUS)-guided transgastric drainage of pancreatic fluid collections (PFC). Methods A retrospective study of 46 patients was performed who underwent EUS-guided transgastric drainage of PFC with placement of LAMS from September 2015 to April 2017. Clinical data were reviewed and follow-up data were obtained by telephone and outpatient contact. Results A total of 49 LAMS were placed in 46 patients ( 2 LAMS were placed in 3 patient respectively for multiport access ) . The operation success rate was 95. 9％( 47/49 ) , complications occurred in 14 patients ( 31. 8％) , including 2 severe complications ( delayed hemorrhage and peritonitis ) . Additional intervention was performed in 10 patients(22. 7％). The mean hospital stay was 6 days (1-40 days) and patients were followed for a mean time of 18. 4 months ( 9-28 months) . Treatment success was achieved in 40 patients( 90. 9％) . Stent removal was performed after a mean time of 59. 4 days ( 20-142 days) , and recurrence rate was 10％( 4/40) during the follow-up period. Conclusion Drainage of PFC using LAMS with special design is effective and relatively safe.
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Objective To develop and validate a model based on deep learning for automatic diagnosis of early gastric cancer ( EGC) to improve detection and diagnosis of EGC. Methods A total of 5159 images ( including 1000 images of EGC and 4159 images of other benign lesions or normal patients) obtained from May 2014 to December 2016 were collected from endoscopic database in changhai Hospital. Then 4449 images were selected randomly for a deep convolutional neural network ( CNN ) training, of which 768 were diagnosed as EGC and 3681 diagnosed as other benign lesions or normal. The remaining 710 images were used to test the model by comparing with diagnostic results of four endoscopists. Results The deep learning model showed accuracy of 89. 4％ ( 635/710 ) , sensitivity of 88. 8％ ( 206/232 ) and specificity of 89. 7％ ( 429/478) for EGC. The mean time required for diagnosis was 0. 30 ± 0. 02 s. The performance of the model was superior to that of four endoscopists. Conclusion The model based on deep learning has high accuracy,sensitivity and specificity for detecting EGC,which could assist endoscopists in real-time diagnosis.